Overseas Student Guard Plus Insurance Policy Plan A, Plan B and Ultimate Plan

Transcription

1 Policy Wordings Overseas Student Guard Plus Insurance Policy Plan A, Plan B and Ultimate Plan Tata AIG General Insurance Company Limited (We, Our or Us) will provide the insurance described in this Policy and any endorsements thereto for the Insured Period as defined in this Policy, to the Insured Persons named in the Policy Schedule and in reliance upon the statements contained in the Proposal which shall be the basis of this Policy and are deemed to be incorporated herein in return for the payment of the required premium when due and compliance with all applicable provisions of this Policy. The insurance provided under this Policy is only with respect to such and so many of the benefits as are indicated by a specific amount set opposite in the Policy Schedule. This Policy will only be valid and in force if the Policy Schedule is signed by a person We have authorized. Authorised Signatory For Tata AIG General Insurance Company Ltd. Atri Chakroborty National Head Operations & Systems Tata AIG General Insurance Company Ltd. Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai Toll Free Helpline No Visit us at

2 Part A: General Definitions We use certain words in this Policy and Policy Schedule, which have a specific meaning and are shown under the heading of General Definitions in the Policy. They have this meaning wherever they appear in the Policy or Policy Schedule and are shown with an initial capital letter. Where the context so permits, references to the singular shall also include references to the plural and references to the male gender shall also include references to the female gender, and vice-versa in both cases. Accident - means a sudden, unforeseen, and involuntary event caused by external, visible and violent means. Acquired Immune Deficiency Syndrome - means the meanings assigned to it by the World Health Organization. Acquired Immune Deficiency Syndrome shall include HIV (Human Immune-deficiency Virus), encephalopathy (dementia), HIV Wasting Syndrome, and ARC (AIDS Related Condition). Age - means completed years as at the Effective Date. Airworthiness Certificate - means the standard Airworthiness Certificate issued by the aviation agency or by the governmental authority having jurisdiction over civil aviation in the country of its registry. Assistance Company - in this case AIG Assist. Common Carrier - means any civilian land or water conveyance or Scheduled Aircraft in each case operated under a valid license for the transportation of passengers for hire. Contracted Departure Date - means the date on which You are originally scheduled to leave on the Trip. This date is specified in the travel documents. Contracted Return Date - means the date on which You are originally scheduled to return from the Trip. This date is specified in the travel documents. Cancellation (of Policy) - means the terms on which the policy contract can be terminated either by the insurer or the insured by giving sufficient notice to other which is not lower than a period of fifteen days. The terms of cancellation may differ from insurer to insurer. This is applicable only in annual multi trip policies. Condition precedent - means a policy term or condition upon which the insurer s liability under the policy is conditional upon. Congenital Anomaly - means a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position. Internal Congenital Anomaly - which is not in the visible and accessible parts of the body. External Congenital Anomaly - which is in the visible and accessible parts of the body. Day - means a period of 24 consecutive hours. Disease/Illness - means a sickness or a disease or pathological condition leading to the impairment of normal physiological function which manifests itself during the Policy Period and requires medical Treatment. 2

3 (a) (b) Acute Condition - is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery. Chronic Condition - is defined as a disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or tests, it needs ongoing or long-term control or relief of symptoms, it requires your rehabilitation or for you to be specially trained to cope with it, it continues indefinitely, it comes back or is likely to come back. Deductible - means a cost-sharing requirement under a health insurance policy that provides that the Insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/ hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured. The deductible is applicable per event. Grace Period - means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received. Such facility is only applicable in Annual multi trip Policies. Hospital - means any institution established for in- patient care and day care treatment of illness and / or injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act,2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act or complies with all minimum criteria as under: has qualified nursing staff under its employment round the clock; has at least 10 inpatient beds, in towns having a population of less than 10,00,000 and at least 15 inpatient beds in all other places; has qualified medical practitioner (s) in charge round the clock; has a fully equipped operation theatre of its own where surgical procedures are carried out; maintains daily records of patients and will make these accessible to the Insurance Company s authorized personnel. IRDA - means Insurance Regulatory and Development Authority. Immediate Family Member - means an Insured Person s legal spouse; siblings; siblings-in-law; parents; parents-in-law; legal guardian, ward; step-parents; who reside in India. Injury - means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent and visible and 3

4 evident means which is verified and certified by a Medical Practitioner / Physician. Inpatient - Inpatient care - means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event. Insured Period(s) - means with respect to the Policy, the period commencing with the Effective Date of the Policy and terminating with the Expiration Date of the Policy as stated in the Policy and any subsequent period for which the Policy may be renewed. Insured Person - means the Insured Person between Age 16 years to Age 35 years who resides permanently in India, named in the Policy Schedule as being eligible to become insured under this Policy and for whom an individual Proposal Form for insurance has been received and approved by Us. Land/Sea Arrangements - means pre-paid travel arrangements for a scheduled tour, trip or cruise included within the description of covered Trips on the Proposal Form and arranged by a tour operator, travel agent, cruise line or other organization. Medical Advise - means any consultation or advice from a medical Practitioner including the issue of any prescription or repeat prescription. Medical Expenses - means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment. Medically Necessary - means any treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in hospital which is required for the medical management of the illness or injury suffered by the insured; must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity; must have been prescribed by a medical practitioner; must conform to the professional standards widely accepted in international medical practice or by the medical community in India. Period of insurance - the period commencing on the Policy Effective Date and expiring on the Policy Effective Date as referred to in the Schedule. Physician/Medical Practitioner - means a person who holds a valid registration from the medical council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or State Government and is thereby entitled to practice medicine within its jurisdiction, and is acting within the scope and jurisdiction of his license. Medical Practitioner will not be (a) an Insured Person or (b) Your Immediate Family Member or c) or anyone who is living in the same household as the Insured. 4

5 Policy - means the insurance contract, the Policy Schedule, and any attached enrollment forms, endorsements, papers or riders. Policy Schedule - means the Policy Schedule attached to and forming part of the Policy. Pre-existing Condition - means any condition, ailment or injury or related condition(s) for which Insured Person had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the commencement of the first Policy issued by the insurer. Proposal Form - means the basis of this Policy and is deemed to be attached and which forms a part of this Policy. Professional Sports - means a sport, which remunerates a player in excess of 50% of his or her annual income as a means of their livelihood. Reasonable and Customary Charges - means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved. Renewal - means the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose of all waiting periods. This is applicable only in annual multi trip policies. Scheduled Airline - means any civilian aircraft operated by a civilian scheduled air carrier holding a certificate, license or similar authorization for civilian scheduled air carrier transport issued by the country of the aircraft s registry, and which in accordance therewith flies, maintains and publishes tariffs for regular passenger service between named cities at regular and specified times, on regular or chartered flights operated by such carrier. Serious Injury or Sickness - means Injury or Sickness certified as being dangerous to life by a legally qualified Physician. Sickness - means illness first manifested and contracted, and commencing after the Effective Date of the Policy Schedule. Single Trip Insurance - means the Trip specified on the Policy Schedule for which the Contracted Departure Date and Contracted Return Date are specified on the Policy Schedule and commences when the passenger boards the aircraft for onward overseas journey and terminates when he disembarks on return to India or contracted date whichever is earlier. Sound Natural Teeth - means natural teeth that either are unaltered or are fully restored to their normal function and are Disease-free, have no decay and are not more susceptible to Injury than unaltered natural teeth. Subrogation - means the the right of the insurer to assume the rights of the insured person to recover expenses paid out under the policy that may be recovered from any other source. An Act of Terrorism - means an act, including but not limited to the use of force or violence and / or the threat thereof, of any person or group(s) of persons whether acting alone or on behalf of or in connection with any 5

6 organisation(s) or government(s), committed for political, religious, ideological or similar purpose including the intention to influence any government and/or to put the public, or any section of the public in fear. Traveling Companion - means up to two (2) named person(s) who is/are booked to accompany You on the Trip. Trip - means any journey during the Insured Period: which starts and finishes in India and involves a destination(s) outside India; which lasts or is expected to last for 365 Days or less if covered under Single Trip Insurance; and in the case of Single Trip Insurance, for which We have the Contracted Departure Date and the Contracted Return Date. Tuition - means all legally required registration fees charged by the registered and accredited educational institution named in the Application Form for required courses (and any applicable laboratory fee for participation in said courses, exclusive of any extra-curricular course fees), and any cost for the use of facilities for attending said courses. For the purpose of this definition, costs associated with room and board and/or textbooks (whether required or not) are not covered. War - means war, whether declared or not, or any warlike activities, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious or other ends. We, Us, Our - means Tata AIG General Insurance Company Limited. You/Your/Yourself - means the Insured Person(s) who is named in the Policy Schedule. Part B: General Exclusions This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of: 1. where the Insured Person is travelling against the advice of a Physician; or receiving or on a waiting list for receiving specified medical treatment; or is travelling for the purpose of obtaining treatment; or has received a terminal prognosis for a medical condition; or 2. any Pre-existing Condition or any complication arising there from it; or 3. suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted Injury or Illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection; or 4. serving in any branch of the Military or Armed Forces of any country, whether in peace or War, and in such an event We, upon written notification by You, shall return the pro rata premium for any such period of service under the circumstances described in a Hazard ; or 6

7 5. being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed; or 6. participation in an actual or attempted felony, riot, crime, misdemeanor, or civil commotion; or 7. operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or 8. any loss arising out of War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power; or 9. ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or 10. the radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or 11. self exposure to needless peril (except in an attempt to save human life); or 12. congenital anomalies or any complications or conditions arising therefrom; or 13. participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sports, any bodily contact sport or any other hazardous or potentially dangerous sport for which You are untrained. This exclusion does not apply to injuries resulting from inter collegiate sports. 14. the Insured Person riding on a motorcycle or any other motorized two wheeled mode of conveyance as driver or as passenger. 15. any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy, or 16. for any loss of which a contributing cause was Your actual or attempted commission of, or willful participation in, an illegal act or any violation or attempted violation of the law or Your resistance to arrest; 17. any loss, injury, damage or legal liability arising directly or indirectly from: Travel in, to, or through Afghanistan, Cuba or Democratic Republic of Congo; or 18. any loss, injury, damage or legal sustained directly or indirectly by: Any terrorist or member of a terrorist organization, narcotics trafficker, or purveyor of nuclear, chemical or biological weapons. 19. Any non medical expenses (list enclosed Annexure I). 7

8 Part C: Postponement of Effectice Date No insurance provided by this Policy shall become effective if You are Hospital confined or disabled, meaning unable to perform the usual and customary daily duties or activities of a person of like age and sex on the effective date of the policy. The coverage will take effect seven (7) days after such Hospital confinement or disability terminates subject to the Pre-existing Condition exclusion. Part D: Uniform Provisions 1. Entire Contract - Changes: This Policy, together with the Proposal Form, as well as any forms, riders and endorsements and papers hereto, constitutes the entire contract of insurance. 2. No change in this Policy shall be valid until approved by Our authorised officer and such approval is endorsed hereon. No agent has authority to change this Policy or to waive any of the provisions of this Policy. Effective Date: Single Trip Insurance: Your Single Trip Insurance will start on the Contracted Departure Date of Your Trip except Trip Cancellation (if such coverage is provided under this Policy) where cover shall commence on the date & hour the Policy Schedule has been countersigned and the total premium has been paid & realised. 3. Renewal Conditions: This Policy will terminate at the expiration of the period for which premium has been paid or on the Expiration Date shown in the Policy Schedule, whichever is earlier. (i) Single Trip Insurance: The Single Trip Insurance is nonrenewable, not cancelable and not refundable while effective. Cancellation of the Policy may be done only prior to the Effective Date stated in the Policy Schedule and will be subject to deduction of cancellation charge by Us. (ii) Annual Multi Trip Insurance: The Policy is ordinarily renewable for life upon payment of premium unless the Insured Person or any one acting on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation under or in relation to this policy or the Policy poses a moral hazard. Grace period delay in payment up to 30 days from the premium due date is allowed where you can still pay your premium and continue your policy. Coverage would not be available for the period for which no premium has been received. Post 30 days from premium due date, if the premium is not paid, the policy will lapse i.e. be terminated. We, however, are not bound to give notice that it is due for renewal. Unless renewed as herein provided, this Policy shall terminate at the expiration of the period for which premium has been paid. We may extend the renewal automatically if opted for by You in the Proposal Form and provided You are eligible for renewal as per age criteria as per Policy terms. 8

9 We will not apply any additional loading on your policy premium at renewal based on your claims experience. Any revision / modification in the product will be done with the approval of the Insurance Regulatory and Development Authority and will be intimated to You atleast 3 months in advance. Your renewal premium for this policy will not change unless we have revised the premium and obtained due approval from Authority. Your premium will also change if you change the plan. 4. Expiration Date: Single Trip Insurance: Your Policy will terminate on the last day for which premium has been paid or on return to India whichever is earlier. Annual Multi Trip Insurance: This Policy will terminate on the Expiration Date shown in the Policy Schedule for which the premium has been paid. However, The Insured Person s coverage under this Policy ends on the earliest of : 1) the Policy Expiration date as stated above; or 2) the Policy is terminated; or 3) the premium due date if premiums are not paid when due; or 4) the date the Insured Person requests, in writing, that his or her coverage be terminated; or 5) the date the Insured Person ceases to be a member of an eligible class(es) of Insured Person as described in the Policy Schedule under Description of Insured Persons, or 6) Termination of the insured journey. In case of individual journey during the Insured Period, it shall expire 90 days or less, from the commencement of each Insured Journey. Further However We may cancel this Policy at any time on grounds of mis-representation, fraud, non-disclosure of material facts or non-cooperation of the insured by giving you a 15 Days notice delivered to You, or mailed to Your last address as appears in Our records, stating when such cancellation shall be effective in the event of your non-cooperation. In the event of cancellation for mis-representation, fraud, non-disclosure of material facts, the policy shall stand cancelled ab-initio and there will be no refund of premium. In the event the Annual Multi Trip policy is cancelled for non-cooperation of the insured or If you cancel the Annual Multi Trip Policy, the premium shall be computed in accordance with Our short rate table for the period the Policy has been in force, provided no claim has occurred and/or no travel has happened up to the date of cancellation. In the event a claim has occurred and/or travel has happened in which case there shall be no return of premium. 9

10 Short rate table: Cancellation Up to 1 month Up to 3 months Up to 4 months Up to 6 months Up to 8 months 5. Territory: This Policy applies to incidents anywhere in the world outside India unless limited by Us through endorsement or specifically restricted in the Policy. 6. Other Contribution: If at the time of a claim there is another insurance Policy or other contract in Your or the Insured Person s name which covers the Insured Person for the same expense or loss,. (in part or in whole), then the Insured Person shall have the right to require a settlement of his claim in terms of any of his policies. The insurer so chosen by the Insured Person shall settle the claim, as long as the claim is within the limits of and according to terms of the chosen policy. 7. Concealment or Fraud: The entire Policy will be void if, whether before or after a loss, You have, related to this insurance, 8. Above 8 months These are retention scale. Claim Procedure : A. Notice of Claim/Loss: It is a condition precedent to Our liability hereunder that written notice of claim must be given by You to Us within 7 days after an actual or potential loss begins or as soon as reasonably possible and in any event no later than 30 Days after an actual or potential loss begins. If Your property covered under this Policy is lost or damaged, You must: 10 ANNUALLY 25 % OF annual Premium 37.5 % OF annual Premium 50 % OF annual Premium 62.5 % OF annual Premium 87.5 % OF annual Premium 100 % OF annual Premium Provided further that, If the amount to be claimed under the Policy chosen by the Policy holder, exceeds the sum insured under a single Policy after considering the deductibles or co-pay (if applicable), the Policy holder shall have the right to choose the insurers by whom claim is to be settled. In such cases, the respective insurers may then settle the claim by applying the principle of Contribution defined in Part A General Definitions. This clause shall only apply to indemnity sections of the policy. (a) (b) (c) (a) (b) intentionally or recklessly or otherwise concealed or misrepresented what we consider to be any material fact or circumstance; engaged in what we consider to be fraudulent, dishonest or deceitful conduct; or made false statements. notify us as soon as possible; take immediate steps to protect, save and/or recover the covered property;

11 (c) (d) give immediate notice to the carrier or bailee who is or may be liable for the loss or damage; notify the police or other appropriate authority in the case of robbery or theft within 24 hours. B. Claim Forms: We, upon receipt of a notice of claim, will furnish You /Your representative with such forms as We may require for filing proofs of loss. C. Time for Filing Claim Forms and Evidence: Completed claim forms and written evidence of loss must be furnished to Us within thirty (30) Days after the date of such loss. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if You can satisfy us that it was not reasonably possible for You to give proof within such time. The Company may accept claims where documents have been provided after a delayed interval only in special circumstances and for the reasons beyond the control of the insured. You shall obtain and furnish Us with all original bills, receipts and any other documentation upon which a claim is based and shall also give Us in a timely fashion such additional documentation, information and assistance as We may require in dealing with the claim. D. Supporting Documentation and Examination: You or someone claiming on Your behalf shall provide Us with all documentation, medical records and information We may request to establish the circumstances of the claim, its quantum or Our liability for the claim within 30 days after the date of such loss. Such documentation will include but is not limited to the following: i. Our claim form, duly completed and signed for on behalf of the Insured Person. ii. Original Bills & Receipts including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill and any attachments thereto like receipts or prescriptions in support of treatment taken iii. All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries. iv. A precise diagnosis of the treatment for which a claim is made. v. A detailed list of the individual medical services and treatments provided and a unit price for each. vi. Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding Doctor s invoice. vii. Any other document as requested by Claims Department which is relevant to the coverage under the policy. E. Time of Payment of Claim: We shall make the payment of claim that has been admitted as payable by Us under the Policy terms and conditions within 30 days of submission of all necessary 11

12 documents / information and any other additional information required for the settlement of the claim All claims will be settled in accordance with the applicable regulatory guidelines, including IRDA (Protection of Policyholders Interests Regulation), In case of any delay in payment as stated herein, We will pay you interest at the prevalent bank rate plus 2 % at the beginning of the financial year in which claim is settled. For the purpose of this clause, bank rate shall mean the existing bank rate as notified by Reserve Bank of India, unless the extent regulation requires payment based on some other prescribed interest rate. F. Payment of Claim: All claims under this Policy that are payable to the You shall be paid in Indian currency. 9. Arbitration: If any dispute or difference shall arise as to the quantum to be paid under this Policy, (liability being otherwise admitted) such difference shall independently of all other questions be referred to the decision of a sole Arbitrator, to be appointed in writing by the parties to or, if they cannot agree upon a single Arbitrator within 30 Days of any party invoking Arbitration, the same shall be referred to a panel of three Arbitrators, comprising two Arbitrators - one to be appointed by each of the parties to the dispute/ difference, and the third Arbitrator to be appointed by such two Arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Indian Arbitration and Conciliation Act, It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this Policy. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this Policy that the award by such Arbitrator/Arbitrators of the amount of the loss or damage shall be first obtained. 10. Assignment of Indemnities: Indemnity, if any, in case of Your loss of life is payable to the nominee named in the Proposal Form provided such nominee survives you by thirty Days; otherwise, indemnity is payable to Your estate. All other indemnities of this Policy are payable to You. Any payment We make in good faith pursuant to this provision shall fully discharge Us to the extent of the payment. 11. Consent of Nominee: Consent of the nominee, if any, shall not be a pre-requisite for any change of nominee or to any other changes in this Policy. 12. Change of Nominee: No change of nominee under this Policy shall bind Us, unless consent thereto is formally endorsed thereon by Our authorized officer. 13. Medical Examination: We, at Our own expense, shall have the right and opportunity to examine You through Our appointed agents whose details will be notified to You when and as often as We may reasonably require during the pendency of a claim hereunder, and also the right and opportunity to obtain a post 12

13 mortem examination report of Your body as permitted by law. Your or Your estate s compliance with the need for such examination report is a condition precedent to establishing liability under the Policy. 14. Legal Actions: Without prejudice to Uniform Provision 9 above, no action at law or in equity shall be brought to recover on this Policy prior to the expiration of sixty (60) Days after written evidence has been furnished in accordance with the requirements of this Policy. If We disclaim liability to You or any Insured Person for any claim, and if You do not notify Us in writing within one (1) year from the date of receipt of the notice of such disclaimer that You do not accept such disclaimer and intend to recover this claim from Us, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable under this Policy. 15. Misstatement of Age: If Your Age has been misstated, all amounts payable under this Policy shall be adjusted to the coverage amount that would have been purchased for the premium paid. In the event Your Age has been misstated, and if according to Your correct Age, the coverage provided by the Policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then Our liability during the period You are not eligible for coverage, shall be limited to the refund, upon written request, of all premiums paid for the period not covered by the Policy. 16. Compliance with Policy Provisions: Failure to comply with any of the provisions contained in this Policy shall invalidate all claims hereunder. 17. Other Interest: No person(s) other than you and/or your nominee (s) named by you in this application form can claim or sue us under this policy. 18. Reasonable Care and Assistance: You and each Insured Person must take all reasonable steps to avoid or reduce, as far as possible, any loss or damage. You and they must also make every effort to get back any property which has been lost. In addition, You and each Insured Person must assist Us in any manner We may reasonably require in relation to the investigation or settlement of a claim or the preservation or enforcement of any rights of subrogation to which we may be entitled. 19. Settlement Of Loss: Claims for lost property will be paid after the lapse of a reasonable time if the property has not been recovered. You must present acceptable proof of loss and the value involved to us. 20. Valuation: We will not pay more than the actual cash value of the property at the time of loss. Damage will be estimated according to actual cash value with proper deduction for depreciation. At no time will payment exceed what it would cost to repair or replace the property with material of like kind and quality. 13

14 21. Subrogation: In the event of any payment under this Policy, We shall be subrogated to all Your rights of recovery thereof against any person or organization or You shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights and provide whatever assistance We might reasonably require of You in the pursuance of Our subrogation rights. You shall take no action after the loss to prejudice such rights Dispute Resolution Clause and Procedure: This contract of insurance includes the following dispute resolution procedure which is exclusive and a material part of this Policy: (a) (b) (c) (d) (a) (b) Nature of Coverage: This Policy is not a general health insurance policy. Coverage for medical expenses in Part D: Coverage of this Policy is intended for Your use in the event of a sudden and unexpected Sickness or Accident arising when You are outside the Republic of India. Pre-existing Exclusion: This Policy is not designed to provide an indemnity in respect of medical services, the need for which arises out of a Pre-existing Condition. Prior Consultation: Any medical services or series of services with a cost greater than $ 1, shall not be covered by this Policy unless You consult with the Assistance Company in the manner set out in the conditions of this Policy. Choice of Law: This Policy will be governed by the law of the Republic of India. Any disputes will be dealt with as provided for by Uniform Provision 9, above and otherwise by the Indian courts. Free Look Period Single Trip Insurance Free look period is not applicable. Annual Multi Trip Insurance - You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy provided no trip has been commenced. If You have any objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation and You will be refunded the premium paid by You after adjusting the amounts spent on stamp duty charges and proportionate risk premium. You can cancel Your Policy only if You have not made any claims under the Policy. All Your rights under this Policy will immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable and available at the time of renewal of the Policy. 24. In the likelihood of this policy being withdrawn in future, we will intimate you about the same 3 months prior to expiry of the policy. You will have the option to migrate to similar Travel insurance policy available with us. 14

15 Part E: Coverage Section : Accidental Death and Dismemberment (Including Loss of Sight or Hearing) We will pay a percentage of the Principal Sum shown in the Policy Schedule if Injury to You results in one of the losses shown in the Table of Losses below. The loss must occur within 365 Days from the date of the Accident which caused Injury. We will pay, provided such disability has continued for a period of 12 consecutive months and is total, continuous and Permanent at the end of this period, the Principal Sum less any other amount paid or payable under: Accidental Death & Dismemberment (Felonious Assault) sections of this Policy, if these coverages are offered under this Policy, as the result of the same Accident If more than one loss results from any one Accident, only one amount, the largest, will be paid. Table of Losses Life 100% Both Hands or Both Feet 100% Sight of Both Eyes 100% One Hand and One Foot 100% Either Hand or Foot and Sight of One Eye 100% Speech and Hearing in Both Ears.. 100% Either Hand or Foot 50% Sight of One Eye 50% Speech 50% Hearing in Both Ears 50% Thumb and Index Finger of Same Hand 25% Loss with regard to: (a) (b) (c) (d) Loss of: Exposure hand or foot means actual severance through or above the wrist or ankle joints respectively; eye means entire and irrecoverable loss of sight; thumb and index finger means actual severance through or above the joint that meets the hand at the palm; speech or hearing means entire and irrecoverable loss of speech or hearing of both ears. For the purposes of the Accidental Death and Dismemberment benefits above, a loss resulting from You being unavoidably exposed to the elements due to an Accident occurring during the Trip will be payable as if resulting from an Injury. Loss must occur within 365 Days of the date of the Accident. Disappearance % of Principal Sum We will pay the benefit for Loss of Life if while on a Trip Your body cannot 15

16 be located within 365 Days after the forced landing, stranding, sinking or wrecking of a conveyance in which You were a passenger or as a result of any Acts of God, in which case it shall be deemed, subject to all other terms and provisions of the Policy, that You shall have suffered loss of life within the meaning of the Policy. Exclusions: In addition to the General Exclusions listed in this Policy this coverage section shall not cover: 1. loss caused directly or indirectly, wholly or partly by: a. infections (except pyogenic infections which shall occur through an Accidental cut or wound) or any other kind of Disease; b. medical or surgical treatment except as may be necessary solely as a result of Injury. 2. any Injury which shall result in hernia. Section : Accidental Death And Dismemberment (Felonious Assault) (Including Loss of Sight or Hearing) We will pay a percentage of the Principal Sum shown in the Schedule if Injury to You results in one of the losses shown in the Table of Losses below due to a loss as a result of a Felonious Assault during Your Trip. The loss must occur within 365 days of the date of the accident which caused Injury. We will pay, provided such disability has continued for a period of 12 consecutive months and is total, continuous and Permanent at the end of this period, the Principal Sum less any other amount paid or payable under: Accidental Death & Dismemberment sections of this Policy, if these coverages are offered under this Policy, as the result of the same Accident. If more than one loss results from any one accident, only one amount, the largest, will be paid. Table of Losses Loss of: % of Principal Sum Life 100% Both Hands or Both Feet 100% Sight of Both Eyes 100% One Hand and One Foot 100% Either Hand or Foot and Sight of One Eye 100% Speech and Hearing in Both Ears 100% Either Hand or Foot 50% Sight of One Eye 50% Speech 50% Hearing in Both Ears 50% Thumb and Index Finger of Same Hand 25% 16

17 Loss with regard to: (a) hand or foot means actual severance through or above the wrist or ankle joints; (b) eye means entire and irrecoverable loss of sight; and (c) thumb and index finger means actual severance through or above the joint that meets the hand at the palm; (d) speech or hearing means entire and irrecoverable loss of speech or hearing of both ears. Definitions: Felonious Assault - means any willful or unlawful use of force upon You that is a felony or a misdemeanor in the jurisdiction in which occurs and which results in bodily harm to You. Exclusions: In addition to the general exclusions listed in this policy this coverage section shall not cover, a Felonious Assault which is: 1. An act of an Immediate Family Member or Traveling Companion; 2. Pre-existing Condition for which care, treatment, or advice was recommended by or received from a Physician within a two year period preceding the Effective Date of Coverage, or a condition for which hospitalization or surgery was required within a five year period preceding Policy Effective Date the Effective Date specified in the Schedule. Section: Accident & Sickness Medical Expense We will pay the Reasonable and Customary Charges, subject to the Deductible shown in the Policy Schedule, for Covered Medical Expenses incurred overseas by You which are not due to a Pre-existing Condition up to the maximum stated in the Policy Schedule for the treatment of an Injury or Sickness sustained by You while this Policy is in effect. Any medical services or series of services with a cost greater than $ US 1 shall not be covered by this Policy unless You consult with the Assistance Company and the cost for such services are authorized in advance by the Assistance Company. Limitations In no event will benefits continue to be provided by Us for any Covered Medical Expenses incurred after the Expiration Date of the Policy or Your return to India whichever is earlier. No benefits are payable for outpatient Covered Medical Expenses incurred after the Expiration date of the Policy. However if, You are still confined in a Hospital overseas after the Expiration Date of the Policy, and Emergency Medical Evacuation is not appropriate or recommended by the Assistance Company, and continued treatment overseas as an Inpatient in a Hospital is Medically Necessary, we will continue to provide the benefits for Covered Medical Expenses incurred to the earlier of your Hospital Discharge or 60 Days after the Expiration Date of the Policy. Definition: Covered Medical Expenses - means expenses incurred overseas by You for services and supplies which are recommended by the attending 17

18 Physician. They include: (a) (b) (c) (d) the services of a Physician; Hospital confinement and use of operating room; anesthetics (including administration), x-ray examinations or treatments, and laboratory tests; ambulance service; e) drugs, medicines, and therapeutic services and supplies; f) dental treatment resulting from Injury sustained to Sound Natural Teeth subject to the per tooth and per occurrence maximums shown in the Policy Schedule. Exclusions: In addition to the General Exclusions listed in this Policy this coverage section shall not cover: 1. services, supplies, or treatment, including any period of Hospital confinement, which were not recommended, approved, and certified as Medically Necessary by a Physician; or 2. routine physicals or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or X-ray examinations except in the course of a disability established by the prior call or attendance of a Physician; or 3. elective, cosmetic, or plastic surgery, except as a result of an Injury caused by a covered Accident while Our Policy is in force; or 4. dental care, except as a result of Injury caused by Accident to Sound Natural Teeth while this Policy is in effect; or 5. expenses incurred in connection with weak, strained, or flat feet, corns, calluses, or toenails; or 6. the diagnosis and treatment of acne; or 7. deviated septum, including sub mucous resection and/or other surgical correction thereof; or 8. organ transplants that are considered experimental in nature; or 9. well child care including exams and immunizations; or 10. expenses which are not exclusively medical in nature; or 11. any expenses incurred in India unless authorized and approved by Us in advance; or 12. eyeglasses, contact lenses, hearing aids, and examination for the prescription or fitting thereof, unless Injury or Sickness has caused impairment of vision or hearing; or 13. treatment provided in a government Hospital or services for which no charge is normally made; or 14. mental, nervous, or emotional disorders or rest cures; or 15. pregnancy and all related conditions, including services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child; birth control, including surgical procedures and devices; or 18

19 16. medical expenses covered under any workers compensation or similar policy; or 17. medical expenses incurred as the result of alcohol and/or drug abuse, addiction or overdose. 18. Any non medical expenses (list enclosed Annexure I). Special Extensions Notwithstanding the above, the Policy has following extensions as specifically provided in the schedule of benefits. 1) Medical expenses related to pregnancy, termination of pregnancy are covered subject to maximum amount as provided in the schedule of benefits under Plan B, Plan Ultimate, subject to waiting period of 10 months from the effective date of Policy. 2) Medical expenses related to treatment for mental and nervous disorders, including alcoholism and drug dependency are cover subject to maximum amount as provided in the schedule of benefits under Plan B, Plan Ultimate. 3) Medical Expenses related to Cancer Screening and mammographic examination on recommendation from a physician are covered subject to maximum amount as provided in the schedule of benefits Section: Assistance Assistance Company will provide the following services as described below. Medical Assistance - As soon as the Assistance Company is notified of a medical emergency resulting from Your Accident or Sickness, the Assistance Company will contact the medical facility or location where You are located and confer with the Physician at that location to determine the best course of action to be taken. If possible and if appropriate, Your family Physician will be contacted to help arrive at a decision as to the best course of action to be taken. The Assistance Company will then organize a response to the medical emergency, doing whatever is appropriate, including, but not limited to, recommending or securing the availability of services of a local Physician and arranging Hospital confinement of You where, in its discretion, deems such confinement appropriate. Medical Evacuation - When, in the opinion of the Assistance Company s medical panel, it is judged medically appropriate to move You to another location for treatment or return You to India, the Assistance Company will arrange the evacuation, utilizing the means best suited to do so, based on the medical evaluation of the seriousness of Your condition, and these means may include air ambulance, surface ambulance, regular airplane, railroad or other appropriate means. All decisions as to the means of transportation and final destination will be made by the Assistance Company. Repatriation - the Assistance Company agrees to make the necessary arrangements for the return of Your remains to India in the event You die while this policy is in effect as to You. 19

20 Legal Assistance - If You are arrested or are in danger of being arrested as the result of any non-criminal action resulting from responsibilities attributed to You, Assistance Company will, if required, provide You with the name of an attorney who can represent You in any necessary legal matters. Lost Luggage or Lost Passport - If You, outside India, notify the Assistance Company that Your luggage or passport has been lost, the Assistance Company will endeavor to assist You by contacting the appropriate authorities involved and providing direction for replacement. General Assistance - the Assistance Company will serve as a central point for translation and communication for You during emergencies. The Assistance Company agrees to provide to You advice on contacting and using services available from consulates, government agencies, translators and other service providers that can help with travel problems. In addition, the Assistance Company will provide insurance coordination, verifying coverage of You, guaranteeing payment to the medical provider, based on confirmation of benefits, a charge to credit card(s) and coordinating the payments, documentation and translation to ease claim filing when You return to India. Pre-Departure Services - prior to Your departure, upon request the Assistance Company will provide hazard information about foreign locations, information about immunization requirements and passport or visa requirements, general information about weather and State Department and private service warnings about travel to certain locations. The Assistance Company will also arrange for special medical care en-route (i.e. dialysis, wheelchairs, etc.). Subject to receiving reasonable notice of this request. Emergency Travel Agency - the Assistance Company agrees to provide You with 24 hour travel agency service for airline and hotel reservations. The Assistance Company will also arrange payment for Your airline tickets and other travel services, using Your credit cards. Prepaid ticket pickup at airline counters or ticket delivery by mail or courier will also be arranged by the Assistance Company for You. Emergency Cash Transfers and Advances - the Assistance Company will arrange for cash payments, to You, through a variety of sources, including credit cards, hotels, banks, consulates and Western Union. The Assistance Company provides this service to supplement the facilities of Your credit cards. Credit card transactions performed by the Assistance Company are subject to confirmed credit. Disclaimer of Liability In all cases the medical professional or any attorney suggested by the Assistance Company shall act in a medical or legal capacity on behalf of You only. The Assistance Company assumes no responsibility for any medical advice or legal counsel given by the medical professional or attorney. You shall not have any recourse to the Assistance Company by reason of its suggestion of a medical professional or attorney or due to any legal or other determination resulting therefrom. You are responsible for the cost of services arranged by the Assistance Company on behalf of You or a covered Immediate Family Member. The 20